Weekly StateVitals Update: Volume 44 (November 3, 2025)

National

ACA Premiums will Increase 26% on Average. Kaiser Family Foundation’s recent research determines that most Marketplace enrollees receive tax credits that base their payments on household income, not the insurer's charge. If these enhanced premium tax credits expire, most enrollees would face significantly higher payments, even with insurers charging 26% more. Extending the tax credits would maintain similar monthly payments for subsidized enrollees despite rising insurer charges. Estimates now show enrollees may face a 100% increase in premiums with the combined insurer increase and loss of tax credits. 

California 

Legislative Analyst’s Office Warns 1.2 Million Will Lose Medi-Cal Coverage.  The bipartisan office released a report estimating federal cuts would reduce funding by tens of millions of dollars. It concluded the state does not have the fiscal capacity to make up for the oncoming federal cuts to healthcare programs used by millions of Californians. About 15 million Californians, and more than half of all children in California, receive coverage through Medi-Cal. Further, experts estimate that California will face a $17 billion budget shortfall next fiscal year.

Illinois

Legislature Passes Measure to Require Hospitals to Implement Policies on Interactions with Law Enforcement. The bill, which has yet to be signed by Governor JB Pritzker (D), mandates that hospitals designate a contact person or persons to be notified of all law enforcement presence and verify the identity and authority of any law enforcement agent involved in civil immigration activities at a hospital site. The bill further establishes a fine for hospitals that fail to submit the policy to the Department of Health. 

Oklahoma

Hospital Transparency Law Takes Effect. Beginning November 1, Oklahoma’s hospitals will be required to post prices for at least 300 frequently used procedures and services online. Senate Bill 889 also mandates that if hospitals fail to comply with this provision, they may lose their ability to collect medical debt from patients. Patients who believe a hospital to be in noncompliance would be able to sue for relief from the debt. Noncompliance would also mean the hospital faces administrative penalties from the Oklahoma Health Department. 

Pennsylvania

House Passes Mandatory Insurance Coverage of Vaccines. House Bill 1828 would mandate that all health insurers cover the entire cost of immunizations. The Pennsylvania House passed the measure along mostly party lines, with only 2 Republicans supporting the bill. It now moves to the Senate, where it faces a Republican majority that opposes the bill on the grounds that it will increase insurance costs.

West Virginia

Federal Court Overturns Opioid “Public Nuisance” Ruling. The Fourth Circuit found on Tuesday that drug distributors may be held liable for the influx of prescription opioids into West Virginia under public nuisance laws. Senior U.S. Circuit Judge Barbara Keenan authored the opinion that overturned a West Virginia federal court's ruling. The lower court had previously determined that local governments could not pursue public nuisance claims based on prescription drug distribution under West Virginia common law. The case will now go back to the U.S. District Court in Charleston. 

For additional information and updates on state activity this past week relative to state COVID-19 vaccine guidance, StateVitals Subscribers can check out our guidance tracker.